How to Add New Payers with Apex

How to Add New Payers with Apex

To add new payers to your payer list for Apex, you must have set Apex as your default clearinghouse through your My Clients Plus subscriptions.  If you are new to My Clients Plus as of 2/1/19, Apex is automatically enabled and is the default payer list.

EDI Enrollment

Some payers require EDI (claim submission) Enrollment before you can submit claims to them electronically.  If you are adding a new payer to your payer list in Insurance Companies and you don't know if the payer requires EDI Enrollment, please click on the Apex Payer Enrollment button and start the enrollment process to see if your payers require EDI Enrollment.  If the payer does NOT need enrollment, you can simply leave the screen and go back to Code Setup > Insurance Company.

Selecting Insurance payers for your Short Electronic Payer List

To add an insurance payer to your short Electronic Payer list, click on +Add New Insurance Company.

  • Your default clearinghouse will be listed at the top indicating the payer list you can access.
  • Click on the Company drop down box to select the payer.
  • Accept Assignment – defaults to “Yes”.  If you are billing as an out of network provider, you may change this to “No”.  
  • Special Overrides to Practice Setup – Any information entered in this section will “Override” any information entered in the Practice Setup.
  • Session Reminder Flags – This section is just a reminder field for you.  Any information entered will be available in the client session when you hover over “Insurance Note” in the upper right corner.  You MUST manually enter the information in the Client Session if you wish to have it on the claim, and after you enter it and save the session, the system will remember it when you enter the next Client Session.

Special Overrides to Practice Setup:

These are the overrides that can be done in the Insurance Company Setup:
  • Print Practice Name – This defaults to “No”, which prints the provider name as the billing provider name in Box 33.  If you need to use the Company name as the billing provider name, this drop-down box must be “Yes”.  If you are billing electronically, it will also send the claim through with the Billing Entity as an Organization.
  • Suppress Taxonomy – defaults to “No”, and the taxonomy number will not be on the claim.  If you are electronically billing Medicaid or an insurance payer that requires a taxonomy number, you must switch this drop-down box to “No”.  You must also enter the taxonomy number in the Practice Setup in the block next to the NPI number.
  • Use Office NPI – If an Office NPI is entered in the Office Locations Setup and this drop-down box is “Yes”, the Office NPI (from Office Locations) will print in block 32a.

If you would like to be able to search the Apex Payer list, you may click here:  Apex EDI Payer List